Provider Demographics
NPI:1639192271
Name:LEWIN, RODERICK W (DMD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:W
Last Name:LEWIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 NICHOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:978-878-8516
Mailing Address - Fax:978-878-8418
Practice Address - Street 1:326 NICHOLS ROAD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:978-878-8100
Practice Address - Fax:978-878-8326
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA88881223S0112X
MA88831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1319833Medicaid
221845OtherUGS
MAX02562OtherBS OF MA
221845OtherUGS
MAX02562Medicare PIN
MAX02562Medicare PIN